ADHD Symptoms Research Articles

Functional Impairment Related to ADHD From Preschool to School Age.

Children with ADHD often experience functional impairments across various aspects of daily life. This study addresses the dearth of longitudinal research on functional impairment trajectories from preschool to school age in children with symptoms of ADHD and comorbid disorders. We investigated the extent to which functional impairments were associated with ADHD symptoms, along with behavioral and anxiety symptoms, from age 3.5 to 8 years. Utilizing parent- and teacher-reported data, we analyzed associations between global impairment, and dimension scores (e.g., family; child quality of life (QoL); learning; play/leisure activities; and friends) and symptoms at ages 3.5 and 8 years (n = 783). The mean parent global impairment score increased from 0.31 (standard deviation (SD) = 0.40) to 0.83 (SD = 0.63) from 3.5 to 8 years, while the teacher impairment scores slightly decreased. Specific parent impairment dimension scores, particularly QoL, learning, and friends, significantly increased. Preschool ADHD and comorbid behavioral symptoms reported by parents weakly predicted impairment at 8 years. By age 8 years, impairment and symptoms exhibited moderate to strong correlations for all impairment dimensions. Parents reported greater child impairment during school age across settings compared to preschool, while teachers' impairment profiles remained consistent across ages. These findings suggest that parents perceive impairment as more pronounced at age 8 years and more strongly associated with symptoms of both ADHD and comorbid disorders than at age 3.5 years. Notably, for teachers, a robust correlation between inattention symptoms and learning impairment was observed, with substantially higher impairment scores reported for boys compared to girls.

The interaction of ADHD traits and trait anxiety on inhibitory control.

Attention-deficit/hyperactivity disorder (ADHD) and anxiety frequently occur together; however, the cognitive outcomes of comorbid anxiety and ADHD are not straightforward. A potential explanation for conflicting results in the literature may be that different core ADHD symptoms show different interactions with anxiety depending on the task-processing demands. To address this question, we investigated whether different ADHD traits are related to different inhibitory outcomes, contingent upon the level of trait anxiety. The sample consists of 60 non-clinical university students ( age = 20.5, 53% male). Conners' Adult ADHD Rating Scale and State Trait Anxiety Inventory were used to measure ADHD traits and anxiety, respectively. The participants completed a visual Go/NoGo task with and without distractor conditions while continuous EEG was recorded. Inhibitory control was operationalized as the frontocentral N2 maximum peak amplitude elicited in response inhibition (NoGo/No Distractor), cognitive inhibition (Go/Distractor), dual inhibition (NoGo/Distractor), and control (Go/No Distractor) conditions. We analyzed the moderating effect of trait anxiety on the prediction of inhibitory control by ADHD scores for each Go/NoGo condition with the varying inhibition demands. Results showed that trait anxiety moderated the effects of total ADHD and hyperactivity-impulsivity scores, but only in the response inhibition condition (NoGo/No Distractor). These findings suggest that depending on the inhibitory demands of the task, unique cognitive outcomes may occur when different ADHD traits coexist with anxiety.

Enhanced neurobiological biomarker differentiation for attention-deficit/hyperactivity disorder through a risk-informed design.

Translation of biomarkers to clinical practice is hindered by the significant overlap in neurobiological measures between ADHD cases and controls. A risk-informed design can enhance the utility and validation of ADHD biomarkers by highlighting differences between individuals with ADHD and those without at differential risk. Participants were 2511 children and adolescents (aged 6 to 14 years) from the Brazilian High Risk Cohort for Mental Conditions. We calculated risk for ADHD among unaffected individuals using a multivariable clinical and sociodemographic risk model. We compared measures of three proposed ADHD biomarkers (polygenic scores, subcortical volumes, and executive function) between participants with vs. without ADHD, and ADHD vs. without ADHD with a high- vs. low-risk loading for ADHD. Compared to the unaffected group, children and adolescents with ADHD had higher ADHD polygenic scores (cohen's d = 0.17), smaller subcortical volumes (d = - 0.25), and poorer executive function (d = - 0.22). Separating the unaffected group into low- and high-risk subgroups revealed more pronounced differences (Cohen's d = 0.20 to 0.60) and nearly doubled the overlap-free area for these three neurobiological measures between the low-risk group and the other two groups. Upon adjustment for the number of ADHD symptoms, simple ADHD vs. without ADHD differences vanished, while the risk-informed analyses remained significant. Here, we demonstrate that a risk-based design increases effect sizes when comparing candidate biomarkers for ADHD. Our study provides a model that may hold promise for evaluating similar contrasts in other mental disorders and samples.

A Risk Factor for Attention Deficit Hyperactivity Disorder Induces Marked Long-Term Anatomical Changes at GABAergic-Dopaminergic Synapses in the Rat Ventral Tegmental Area

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. However, the core biology of the disorder that leads to the hypofunctioning of the cerebral dopaminergic network requires further elucidation. We investigated midbrain synaptic changes in male rats exposed to repeated hypoxia during the equivalent of extreme prematurity, which is a new animal model of the hyperactive/impulsive presentation of ADHD. We used a novel combination of a lentiviral vector, peroxidase-immunonanogold double-labelling, three-dimensional serial section transmission electron microscopy and stereological techniques to investigate the synapses formed between GABAergic axons of the rostromedial tegmental nucleus (RMTg) and dopaminergic neurons of the posterior ventral tegmental area (pVTA). This is a key site that sends extensive dopaminergic projections to the forebrain. We also compared the results to our previous study on a schizophrenia risk factor that produces cerebral hyperdopaminergia. In total, 117 reconstructed synapses were compared. Repeated hypoxic rats had a significantly thicker (22%) and longer (18%) postsynaptic density at RMTg GABAergic-pVTA dopaminergic synapses compared to their controls. These results were opposite to those previously observed in rats exposed to a schizophrenia risk factor. These findings for repeated hypoxic rats suggest that the enhanced inhibition of pVTA dopaminergic neurons may contribute to hypodopaminergia in ADHD motor hyperactivity. Synaptic triads, a key component of pVTA circuitry, were not detected in repeated hypoxic rats, indicating a marked deficit. The current knowledge may guide development in males of novel, site-specific ADHD drugs, which is necessary due to the rising prevalence of ADHD, the chronic nature of ADHD symptoms and the limitations of the currently available medications.

Drug Holidays May Attenuate Beneficial Effects of Treatment on Emotion Regulation and Recognition Among Children with ADHD: A Single-Center, Prospective Study.

In this study, we aimed to evaluate the effects of drug holidays during summer vacations on children with attention deficit/hyperactivity disorder (ADHD) treated with methylphenidate in terms of ADHD symptoms and emotion regulation (ER). This single-center, naturalistic, prospective cohort study included pre-, post-, and post-drug holiday evaluations. All patients diagnosed with ADHD and included in our study were administered the Clinical Global Impression Scale, Affective Reactivity Index-parent and child, reading the mind in the eyes test (RMET), Faces test and Cognitive Emotion Regulation Questionnaire for Children 3 times. Fifty-six patients met the inclusion criteria and ten were lost to follow-up. Thirty-nine participants had complete evaluations at all time points. Both parent and self-report ratings of child irritability were significantly reduced after methylphenidate (MPH) treatment (P=.003 and .002, respectively), although they returned to baseline after drug holidays (P=.618 and .974, respectively). The use of self-blame as a cognitive emotion regulation strategy increased significantly after treatment and remained significantly elevated even after drug holidays (P=.024 and .022, respectively). Children used planning as a cognitive strategy significantly more frequently during MPH treatment (P=.034), although this elevation was temporary and returned to baseline levels after the drug holidays (P=.890). Reading the mind in the eyes test performance was significantly improved after MPH treatment and did not change after drug holidays (P=.009 and .006, respectively), while there was a tendency for facial emotion recognition abilities to improve at the last visit (P=.051). Our results suggest that MPH treatment improves child- and parent-reported irritability, clinician-rated disorder severity, RMET performance, and the use of planning as a cognitive ER strategy, although only improvement in RMET performance continued after drug holidays. Our results may support the importance of continuing treatment over the holidays for most children with ADHD unless necessitated by adverse events, growth problems, or development of tolerance.

The effects of a four-month skateboarding intervention on motor, cognitive, and symptom levels in children with ADHD

Objectives and methodsThis study aimed to investigate whether a four-month skateboarding workshop can positively affect attention-focusing skills and postural control in terms of static and dynamic balance in addition to symptoms of ADHD in school-aged children (N = 58). Kinematic and kinetic movement analysis, attention-focusing tests as well as symptom questionnaires were employed to measure differences caused by the skateboarding intervention. A weekly skateboarding workshop was conducted with children diagnosed with ADHD which intended to encourage children to autonomously engage in physical activity. Group differences were analyzed using a generalized linear mixed model. A partial correlation was used to investigate possible relationships between the variables.ResultsA preceding analysis confirmed that children with ADHD perform statistically significantly inferior in the employed tests of balance and concentration ability than unaffected peers of the same age. The main analysis showed that after the skateboarding intervention, children with ADHD were able to improve cognitive and motor test performances as well as symptom expression significantly. Significant improvements were likewise found in the waitlist control group, these were however less pronounced compared to those of the skateboarding intervention group. The correlation analysis revealed that there is no reciprocal influence between cognitive and motor skills, nor between motor skills and ADHD symptomatology in the present patient group. Possible explanations are discussed.ConclusionSkateboarding as a form of movement intervention can be considered an effective method for children with ADHD to deal with their symptoms and deficits. An intervention period of four months has helped children with ADHD discover and embrace an informal sport like skateboarding, thereby finding enjoyment in movement and practice a skill from intrinsic motivation. To retain the benefits, it is advisable to practice a sport on a long-term basis. Thorough conceptualizations to implement this type of therapy await further research.

Mental disorder diagnoses and symptoms and functional impairment in school-age children in the care of child protective services

BackgroundAbout 50 % of children in the care of child protective services present at least one mental disorder, but few studies have looked at whether there are differences in mental disorders or symptoms between children placed in out-of-home care (foster care and residential care) and their community peers. ObjectiveThis study documents the mental disorder diagnoses and symptoms among children in out-of-home care and their associations with children functional impairment. It also compares out-of-home care children with those from the community. Participants and settingThe sample was composed of children aged 5 to 12 years in foster care (n = 154), in residential care (n = 111), and from the community (n = 92). MethodsCaregivers reported the children's diagnoses and completed questionnaires on the children's symptoms. Results1) Proportionally more children in out-of-home care presented a mental disorder than did children from the community. Proportions were similar for those in foster care and those in residential care; 2) Children in out-of-home care presented more symptoms than those from the community for all the mental disorders considered and the children in residential care presented more symptoms than did those in foster care for about half of the disorders considered; 3) symptoms were strongly associated with functional impairment; and 4) the symptoms of RAD, ADHD, OCD, CD, and ODD proved significant predictors of functional impairment. ConclusionsThis study provides a picture of the mental disorders and symptoms among samples of school-age children in the care of child protective services and raises questions about the proportions of some of the diagnosis that children receive.

Toddler Screen Time: Longitudinal Associations with Autism and ADHD Symptoms and Developmental Outcomes.

Greater screen time is associated with increased symptoms of autism spectrum disorder (autism), attention-deficit/hyperactivity disorder (ADHD), and lower scores on measures of development in preschool-aged community samples. In the current longitudinal study, we examined screen time differences at 18months of age based on clinically-defined outcomes (i.e., Autism, ADHD Concerns, Comparison) determined at age 3-5years in a genetically-enriched sample based on family history, along with prospective associations between toddler screen time and preschool autism/ADHD symptoms and developmental achievement. Participants (n = 82) included children at high and low familial likelihood for autism and ADHD. Children with Autism and ADHD Concerns outcomes experienced significantly more screen exposure at 18months than children without autism or elevated symptoms of ADHD. Greater screen time at 18months was also associated with preschool symptoms of autism and ADHD and lower developmental achievement across the sample. Preschoolers with neurodevelopmental challenges experienced more screen exposure earlier in development than same-age peers, increasing potential for negative developmental impacts.

Szisztematikus szakirodalmi áttekintés a figyelemhiányos/hiperaktivitás-zavarral élő gyermekek bántalmazása hátterében álló egyéni és interperszonális rizikófaktorokról

Objective: To provide comprehensive knowledge of the factors behind abuse by parents of children with attention-deficit/hyperactivity disorder (ADHD). Are children with ADHD are really at increased risk of child abuse? Is there a relationship between the onset of ADHD (hyperactive/impulsive-, attention deficit, combined) and the type of abuse? Does parental ADHD predispose to abuse? Finally, what are the long-term effects on a child with ADHD? Method: The study is following the PRISMA guidelines, 32 out of 683 studies were selected in the study sample. Result: The group of children with ADHD can indeed be identified as a risk group. The hyperactive type was associated with physical and emotional abuse and neglect of parental authority, attention deficit was associated with physical and sexual abuse, and custody and physical neglect. Parental ADHD has been identified as a risk factor, too. The long-term consequences were drug-use, in addition to the intensification of ADHD symptoms. Conclusion: We argue for the risk factor-reducing importance of parental education and psychological therapy.

E-cigarette Quit Attempts in Emerging Adults: Motivations for Attempts and Predictors of Cessation Barriers.

Although young adults use electronic nicotine delivery systems (ENDS) more often than any other demographic group, most are interested in cessation; however, little is known about their cessation experiences. The present study examined characteristics associated with quit attempts, reasons for quitting and resources utilized, and psychological symptoms [i.e., depression, anxiety, anxiety sensitivity, attention-deficit/hyperactivity disorder (ADHD)] associated with cessation barriers. College-attending adults from six U.S. institutions who endorsed lifetime ENDS use (N=2007; 75% female) completed a one-hour online survey between Fall 2022-Spring 2023. More than half of participants (53%) made a cessation attempt; of those participants, more than half (53%) made multiple attempts. Male sex; college region; earlier ENDS initiation; higher ENDS dependence; disposable or pod device use; and past 30-day combustible use were associated with cessation attempts. Health concerns motivated many quit attempts (44%), although participants identified a range of reasons that converged with prior research. Unassisted cessation methods were most common [e.g., cold turkey (68%), willpower (53%)]. Although utilized far less often, replacing vaping with another activity, support from family/friends, nicotine replacement, and prescription cessation medications were perceived to be helpful. Anxiety sensitivity and ADHD symptoms were associated with more barriers to cessation, particularly with affect management and withdrawal. ENDS quit attempts are common among young adults, particularly males and those with higher dependence, but largely are unassisted. Encouraging the use of multiple interventions and tailoring interventions to those with psychological vulnerabilities are critical next steps to improving young adults' success with ENDS cessation. Young adults are motivated to quit ENDS for a wide range of intra- and interpersonal reasons. However, their limited uptake of ENDS cessation resources suggests an opportunity to better publicize and increase access to these resources, particularly to digital resources, nicotine replacement therapy, and prescription cessation medications. To be maximally effective, cessation interventions should be multipronged and address the unique challenges faced by individuals with greater anxiety sensitivity and ADHD symptoms, prominent issues in this developmental stage.

Mind Marvel platform: Transforming attention deficit hyperactivity disorder challenges into opportunities through interactive gaming

Attention deficit hyperactivity disorder (ADHD) is a neurological disorder marked by a pattern of inattention, hyperactivity, and/or impulsivity. Since the signs and symptoms of ADHD can be observed in the early stages of childhood, a prompt diagnosis, along with effective treatment, is of utmost importance. Once a child is diagnosed, various treatments are available, including behavioral therapy, medication, and cognitive training. Recent research has shown that individuals with ADHD tend to respond well to interactive games and technologies, such as virtual reality (VR) since such activities require timely task completion, attention to detail, and concentration. Thus, the purpose of this study is to leverage on game therapy for ADHD and develop Mind Marvel, a unique platform for individuals with ADHD. This platform combines the design of interactive webpages with a VR environment, transforming ADHD challenges into opportunities through such interactive gaming. In this case, the user answers a set of questions and plays a VR game by using a computer mouse and keyboard or a commercial VR controller. This platform has been tested under laboratory conditions, after which preliminary results indicate that the capabilities of the Mind Marvel system effectively support individuals with ADHD and raise awareness of their conditions.

Results of N = 1 randomized, double-blind, placebo-controlled, cross-over discontinuation trials embedded in clinical practice after longer term methylphenidate use: a pilot study.

Attention-deficit/hyperactivity (ADHD) guidelines recommend that the need for continued stimulant medication treatment of children and adolescents needs to be reviewed at least annually. We aimed to assess the outcomes in clinical practice of placebo-controlled discontinuation trials after long-term methylphenidate treatment. We asked clinicians to implement N = 1 randomized, double-blind, placebo-controlled, cross-over discontinuation trials after at least one year of methylphenidate treatment of children and adolescents (n = 26, 6-15 years of age). We analyzed the effectiveness of ongoing methylphenidate treatment compared to placebo on symptoms of ADHD, oppositional defiant disorder, and conduct disorder according to both parents and teachers, and the global improvement or deterioration according to the clinicians. We also assessed the proportion of individuals who continued using methylphenidate after the discontinuation trial. Teacher-rated hyperactivity and impulsivity symptoms were significantly lower during methylphenidate treatment compared to placebo (β = 3.80, SD = 1.69, t = 2.25, p =.04). No other significant differences were found between methylphenidate and placebo. Almost two-thirds (n = 16, 61.5%) of individuals continued using methylphenidate after the discontinuation trials, of which seven did not deteriorate during placebo according to their clinician. Our findings support the need for regular evaluations of methylphenidate treatment effectiveness and emphasize the importance of including the school setting when evaluating treatments. Better guidance for clinicians when to continue or cease methylphenidate treatment is urgently needed.

Is there a link between peripheral inflammation and blood brain barrier integrity in children with attention-deficit/hyperactivity disorder? A case-control study.

Claudin-5 is a vital constituent of tight junctions, which are critical elements of the blood-brain barrier. In people with neuropsychiatric disorders, peripheral inflammation is often found, although it is less common in healthy populations. The objective of this study was to examine the relationship between Claudin-5, peripheral immune cells, and the severity of symptoms in children with attention deficit hyperactivity disorder (ADHD). The study included a cohort of 33 children diagnosed with ADHD and 29 control subjects, all aged between 5 and 12 years. The intensity of ADHD symptoms was evaluated using Conner's questionnaire, which the parents completed. Each kid had serum level measurements of Claudin-5 and a complete blood count in order to establish a correlation with symptoms of ADHD. Serum Claudin-5 levels are lower in the ADHD group compared to the control group; median (IQR) = 30.94 (4-137) and 44.12 (4-223.3) respectively (p = 0.69). The levels of neutrophils and neutrophil/lymphocyte ratio are significantly higher in ADHD than in controls (p = 0.011 and 0.015, respectively). Lymphocytes have a significant positive correlation with ADHD symptoms severity, namely, total Conner's scale and inattention (p = 0.021 and 0.004 respectively), while NLR has a significant negative correlation with total Conner's score and impulsivity (p = 0.046, p = 0.038), also a negative correlation yet not significant between serum Claudin-5 level and total Conner's score, hyperactivity, impulsivity, and inattention. Neutrophils were found to have a significant positive linear regression with Claudin-5 (p = 0.023). These results revealed that BBB integrity is affected in ADHD children, as claudin-5 levels were found to be lower in children with ADHD, lymphocytes were found to be associated with increased ADHD symptoms severity, and NLR was associated with decreased symptoms severity, which may be via the positive effects of increased neutrophils on Claudin-5 levels.

Adult Diagnosis of ADHD in Women: A Mixed Methods Investigation.

The goal of this study was to examine the experiences of women diagnosed with ADHD in adulthood. Benefits and costs associated with obtaining the diagnosis were examined in two focus groups conducted virtually. Factors hindering and facilitating the identification, assessment, and subsequent treatment of ADHD were also explored. Focus groups were conducted virtually and together included 14 women (Mage = 39.43, SD = 6.37) who were diagnosed with ADHD in adulthood. The majority of women described numerous benefits of receiving a diagnosis of ADHD, including validation/self-compassion, adaptive coping, and social support. Negative aspects of the diagnosis, including difficulties accessing care, the burden of care, limitations to existing evidence-based treatments, and stigma were also identified by some women. Furthermore, women described variable diagnostic experiences, with many indicating that they had not recognized their own symptoms of ADHD, as well as diagnostic complexity and other factors that masked identification of ADHD. Women described a range of diagnostic assessment procedures, as well as considerable self-advocacy to convince their providers to consider the diagnosis of ADHD. These lived experiences of women diagnosed with ADHD provide critical insight into improving clinical care for ADHD in women. Recommendations to increase accurate and timely identification of ADHD in women and advance efforts toward effective and equitable care are discussed.

Sensory processing subtypes relate to distinct emotional and behavioral phenotypes in a mixed neurodevelopmental cohort.

Children with autism and other neurodevelopmental concerns (NDC) frequently exhibit an array of sensory processing dysfunction phenotypes, posing a significant challenge their adaptive development. Additionally, these children often encounter difficulties with self-regulation, including emotion dysregulation, anxiety, and symptoms associated with attention and hyperactivity. However, further research is required to comprehend how patterns of sensory processing differences across neurodevelopmental conditions may contribute to regulatory control problems. Adopting a transdiagnostic perspective within the Research Domain Criteria (RDoC) framework, this study examined the relationship between clusters of sensory processing phenotypes and differential patterns of self-regulation behaviors. We recruited a sample of 117 participants (8-12 years) with a diverse range of neurodevelopmental concerns including autism, ADHD, anxiety, and sensory processing differences. This study aimed to (1) establish the prevalence of self-regulation problems in a community-recruited cohort of children with diverse NDCs; (2) construct data-driven sensory processing latent subtypes; (3) investigate group differences in emotion dysregulation, anxiety, and ADHD symptoms. Results showed that 39% of NDC children met clinically concerning thresholds for emotion dysregulation, 19% for anxiety, and 62% for ADHD. Second, latent profile analysis identified five sensory processing subtypes categorized by modality: Typical Processing, Intermediate/Mixed, Sensory Over-Responsive, Sensory Seeking, and Sensory Under-Responsive. Notably, the Sensory Over-Responsive group exhibited distinctively elevated anxiety scores, while the Sensory Seeking and Sensory Under-Responsive groups showed heightened ADHD scores. Intriguingly, the Sensory Over-Responsive, Sensory Under-Responsive, and Sensory Seeking subgroups all demonstrated elevated emotion dysregulation scores, suggesting a potential shared mechanism of emotion dysregulation that might elucidate the connection between sensory processing differences and increased anxiety and ADHD behaviors in children with autism and other NDCs.

Comprehending self-compassion manifestations and their relationships among adults diagnosed with ADHD: A foundation for recovery-based interventions

Background: Enhancing self-compassion ( SC) was found to enhance Quality of Life ( QoL). There is a need to comprehend SC manifestations among adults with attention deficit hyperactivity disorder (ADHD) who experience low QoL to provide a foundation for Recovery-based interventions aiming to enhance SC and QoL among adults with ADHD. Objective: To explore SC manifestations and their relationships with ADHD symptoms and ADHD related QoL. Methods: A cross-sectional survey used self-rated questionnaires for ADHD symptoms, QoL and SC among 32 adults with ADHD, recruited by a volunteer community sampling. Results: Moderate overall SC was noted. Negative SC means were found to be higher than the positive SC means. The positive SC subscale common humanity had the lowest mean while the negative SC subscale overidentification had the highest mean. Overall SC level was found to significantly contribute to ADHD symptoms in predicting QoL variance. Overidentification was found to be a significant partial mediator between ADHD symptoms and QoL. Conclusion: Recovery-based interventions aiming to decrease the tendency of adults with ADHD to overidentify with their negative thoughts and feelings and to enhance their realization that their difficulties are shared by others, may have the potential to enhance SC and QoL.

Temperament and executive functioning correlates of ADHD symptom severity during early versus middle childhood.

This study investigated associations among temperament, executive functioning (EF), and attention-deficit/hyperactivity disorder (ADHD) symptom severity at two developmental stages. Participants were 61 4-year-old children and 165 8-11-year-old children (126 ADHD, 39 typically developing [TD]). Caregivers reported on temperament (effortful control [EC], negative affect, and surgency), and ADHD symptoms. Three aspects of EF (working memory, inhibitory control, and processing speed) were measured with neuropsychological tests. Among 4-year-olds, variance in ADHD symptom severity was only explained by the temperament variables. EC was not significantly correlated with any of the EFs in this cohort. Among school-aged children, low EC, high surgency, high negative affect, and reduced working memory were associated with greater ADHD symptom severity. EC was significantly and positively correlated with processing speed in the school-aged children. Results are consistent with a neurodevelopmental model of ADHD, wherein dysregulated temperament is associated with ADHD in young children, while both dysregulated temperament and cognitive skills are associated with ADHD in middle childhood. Results could inform the selection of clinical tools for diagnostic evaluation of pediatric ADHD symptoms and clinical follow-up.

The efficacy of behavioral sleep intervention on sleep problems among children with attention-deficit hyperactivity disorder: A randomized controlled trial.

Attention-deficit hyperactivity disorder (ADHD), affecting 5% of global children, presents inattention, hyperactivity, and impulsivity. Sleep problems, prevalent in 70% of cases, exacerbate long-term psychosocial challenges. This study aimed to assess the efficacy of behavioral sleep intervention in alleviating sleep problems, enhancing quality of life (QoL), and reducing ADHD symptom severity among children diagnosed with ADHD. A randomized controlled trial was conducted from June 2022 to April 2023. The intervention group (n = 47) engaged in a hybrid approach, participating in both face-to-face and Zoom sessions, while the control group (n = 45) received standard care. Data collection involved administering the Children's Sleep Habits Questionnaire (CSHQ), Pediatric Quality of Life Inventory (PedsQL), and ADHD Rating Scale IV (ADHD-RS-IV). Significant enhancements were observed in CSHQ (p ≤ 0.001, effect size = 1.913), PedsQL (p ≤ 0.001, effect size = 1.862), and a notable reduction in ADHD-RS-IV (p ≤ 0.001, effect size = 1.548). These findings highlight the intervention's efficacy in improving sleep quality, QoL, and reducing ADHD symptomatology. This trial contributes substantially to understanding behavioral sleep interventions' impact on ADHD-affected children, enhancing quality of life and ADHD symptomatology. The study highlights the importance of individualized care for optimal outcomes in children with ADHD. The study's findings underscore the potential for integrating behavioral sleep interventions into routine nursing practices, offering a valuable approach to address sleep-related challenges in children with ADHD. By focusing on sleep improvement, nurses can contribute to enhancing overall well-being and emotional regulation in these children within the context of comprehensive healthcare.

The prevalence of undiagnosed attention-deficit/hyperactivity disorder among undergraduate medical students: a survey from Pakistan

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is now acknowledged as a significant public health concern, a persistent neurodevelopmental disorder. It poses challenges across various life domains, persisting into adulthood, and is often undiagnosed. From July 2023 to December 2023, this study investigated the prevalence, types, participants’ knowledge and perceptions, and demographic determinants of undiagnosed adult ADHD among undergraduate medical students in Pakistan.MethodsThis cross-sectional study enrolled 342 undergraduate medical students who fulfilled the selection criteria. The data was collected using an online self-administered survey consisting of three main parts using the WHO 18-question Adult ADHD Self-Report Scale, Version 1.1 (ASRS-v1.1), to assess adult ADHD symptoms. Data analysis was conducted using SPSS (version 26.0).Results119 medical students, or 34.8%, had adult ADHD. Inattentive dominance was the most prevalent presentation at (86, 72.3%), followed by mixed dominance at (20, 16.8%), and hyperactive dominance at (13, 10.9%). There was a statistically significant (p < 0.05) association between individuals who screened positive for adult ADHD and had co-occurring psychological disorders (e.g., anxiety, depression) and a family history of psychiatric disorders (e.g., ADHD, generalized anxiety disorder, bipolar disorder). Additionally, these individuals perceived that individuals with adult ADHD could live a normal life despite their condition. While the type of ADHD was significantly associated with the use of medications for psychological disorders, it was significantly higher among hyperactive dominants (5,71.4%), and the family history of GAD was significantly higher (2,10.0%) among mixed dominants.ConclusionThis study reveals a significant prevalence of undiagnosed adult ADHD and an inattentive dominance among medical students in Pakistan, highlighting gaps in awareness and screening. These findings emphasize the crucial need for implementing ADHD screening programs.

Umbrella Review and Meta-Analysis: The Efficacy of Nonpharmacological Interventions for Sleep Disturbances in Children and Adolescents.

We conducted an umbrella review of systematic reviews (SRs) - with or without meta-analysis (MA) - of randomized controlled trials (RCTs) assessing non-pharmacological sleep interventions for children and adolescents across various clinical populations. We searched multiple electronic databases up to 24/01/24. Meta-analyzable data from RCTs in the retrieved SRs/MAs were pooled using Metaumbrella. Primary outcomes were subjective/objective child sleep parameters. Additional outcomes included child health/functioning and parental sleep/health. The quality of the MAs/SRs was assessed with AMSTAR-2, and the certainty of evidence using GRADE. We included 93 SRs/MAs covering 393 RCTs, with 25 (17%, 39% and 30%: high, moderate, and low quality) providing data for quantitative synthesis. Behavioral interventions, usually multicomponent including parent training, psychoeducation, and/or specific sleep therapy/strategies, showed beneficial effects on night waking, sleep duration, overall sleep disturbance, mood/depression, and maternal sleep quality (standardized mean difference [SMD]: 0.10 to 0.80) in participants with sleep problems without a formal sleep disorder diagnosis. For those with a formal diagnosis (mainly insomnia), benefits were found for night waking, sleep efficiency (subjective/actigraphically measured), and sleep onset latency (mean SMD: 0.49 to 0.97). Those with ADHD improved in bedtime resistance, night waking, parasomnias, sleep anxiety, ADHD symptoms, sleep disturbance, and quality of life (mean SMD: 0.18 to 0.49). For those with autism, sleep disturbance improved (mean SMD: 0.70). However, all findings were of low to very low certainty of evidence. Among non-pharmacological interventions for sleep difficulties in youth, only behavioral interventions are supported by meta-analytic evidence, yet with small to moderate effect sizes and limited certainty of evidence.